14 year-old Shih Tzu With Recent Cushing's Diagnosis

[jmac]

Hello-

We're thinking of starting Hannah on a joint supplement to see if it does anything to help her back end. My vet told me about a few options and gave me brochures to look at. I think sometimes he likes to give me the choice, but I would also like his professional opinion. The choices are: Phycox, Synovi, and Cosequin. He seemed to think Cosequin offered the less friendly dosing option for her if that makes sense. The only thing he said was that Phycox says it blocks the COX-2 enzyme to reduce inflammation, which he said is sort of like what Metacam does.

We are going back tomorrow to have her eye checked, and I also might have him check her ears, as she's been itching a lot. I might also start one of these. Does anyone have experience with any of these?

Thanks!
Julie & Hannah

[MBK]

Hi, Julie -

What did your vet mean by "less friendly dosing option"? Both mine have taken Cosequin for quite awhile and seem to do well on it. Alivia is 13 and Maxwell is 11. Initially they started on one tablet a day and then after a week or so you cut back to 1/2 tablet per day. The tablets are large and supposedly chewable, but neither of mine will take them like that. I crush it in a pill grinder and mix it with their food. I'm not personally familiar with either of the other two so I can't offer any comparison. It is definitely worth a shot for you to try one but it will take a few weeks to see if there is any improvement.

Good luck!!!

[jmac]

Hi Mary Beth,
I think he just meant that the other options would last her longer...or that because I said she probably wouldn't chew the chewable ones he thought these would be better because they are soft chews??? I'm not sure what Hannah would or would not actually chew (eat). I will ask again tomorrow. He really seemed fine with me choosing whatever I wanted, and that I could get it there, or buy it myself (he said they don't mark it up). I have no idea which one to use and have only heard of Cosequin. I guess I'll wait to hear from others, and then ask for more info. tomorrow.

Where do you buy yours?

Thanks for your help!

Julie & Hannah

[apollo6]

Dear Julia and Hannah
You have always been kind to check on me. As far as the Cosequin goes, I have been using it for years on Apollo.
I have used Nutramax-Cosequin-Double-Strength-Chewable-Tablets.
I would put the name in google search and see what you come up with. Petmart, Petco, Dr Fosters might have. I bought the last one from Trader Joe's their brand.
You must be sure it is for the right size of dog you have.
Hope this helps.
Hugs Sonja and Apollo




http://www.amazon.com/Nutramax-Coseq...5117351&sr=8-1

[jmac]

Hi Sonja (& everyone else too!)-

I haven't posted in a while, but Hannah has not had any major changes. I did put her on Cosequin (the same one Sonja is using) about 2 1/2 weeks ago, and I do think it is helping her a little bit. She has jumped up onto the couch and the bed a couple of times, but it is still not a regular thing. I know it takes 4-6 weeks before I am supposed to see a big difference, so we'll see. She does seem a little better while walking and going poop, so I'm pleased with that.

Hannah has had some issues with straining to poop when she doesn't go every day (which I'm not surprised about), so I am trying to see if I can stimulate her with short walks, but otherwise the vet told me to try the pumpkin. She has been barking at us and scratching at our legs at night, usually a couple of hours after she eats supper, and I assume she is telling us she wants more food. This stopped for a while after going on Anipryl (back in April), but seems to be picking up again and has been going on for the last couple of weeks. The eating and drinking are still not over the top, and still no coat or skin issues, no pot belly, no panting, so regardless we'll stick with the Anipryl for now.

I've been trying to just enjoy the uneventful times with her and to not worry about every little thing, as long as she is happy. I teach 3rd grade, so I know I'll have plenty of stress with the beginning of the school year.

Thanks for checking in, Sonja! Although I have not been on here as often because of getting back to work, I'll still be checking in. And I'll definitely be back to posting when I have questions about Hannah.

-Julie & Hannah

[jmac]

Hi-
I have been so busy with the start of a new school year and last night I came home with a horrible migraine and was in bed all night. Ugh! Anyway, I have wanted to check in and get some input about Hannah.

It seemed that her hind legs were improving (she was jumping up occasionally and walking a little faster/further) after being on Cosequin. We started Aug. 19th, so it hasn't been a month yet. Lately though, she has been struggling again. The other night she was going soooo slowly up the steps and stopped halfway up. I ended up telling her to stop and carrying her. I also noticed she was definitely using her front end more than her back to get up the step onto the deck. She also has not jumped up for several days, and was REALLY dragging on the last couple of walks. I'm not sure if this is a sign of Cushing's getting worse, or if it could just still be something she has done. I have not had a chance to talk to my vet yet, but the original suspicion was that she strained or injured something in her legs (back checked out okay from them feeling) and that is why she was hesitant to jump unless the reward was worth it. I'm wondering if maybe she injured herself again from overdoing it a bit...

She has also been vocalizing more in the evenings (not overnight), about an hour after dinner, usually from about 6:30 to 8:30. She barks at us, and sometimes will then scratch our legs if we ignore her. I assume she wants food and sometimes I give her a little more, as she is not at all overweight. Sometimes I give her a rawhide and that does the trick, but not always. She also has terrible allergies right now and is so itchy. It's terrible. I have a call into the vet about what I can do besides Benadryl. She used to take a steriod at this time, which is obviously not an option anymore. I also have that pheromone spray you can put on a bandanna and put around their neck to keep them calm. That seems to work well to get her to sleep. She just seems so miserable. I am sometimes wondering if the barking is due to being so frustrated with how itchy she is.

The issue is I am struggling with the thought of is this all Cushing's related, or not?? She still is not a voracious eater. She eats quickly, but doesn't totally inhale her food, and she will wait until Izzy walks away from her dish before digging in; she doesn't push her out. She does drink a lot, but not "buckets." She doesn't empty a water bowl (medium sized) in a day, and this is with Izzy drinking too. Still no other signs....

I got a message from the other vet that said I could try increasing her Anipryl to the full 10mg pill each day since I did notice a decrease in that barking behavior when she started back in April. I'm open to that, but the pills cost me $87 for 30, so that is significant. We talked about the other option being different treatment. I am open to that at some point, if necessary, but I don't feel confident that her symptoms are strong enough for me to be able to see a major difference. I don't know how I would measure the food thing because I don't think she eats THAT differently from how she ever did. She likes her food. I could TRY to watch how often she gets drinks, but after she licks and chews herself for awhile she always gets a drink, so that could be somewhat related to allergies. I am just worried about her back legs getting really weak. I guess my gut tells me it isn't time to move to something stronger because I don't want her to end up really sick or dead because of getting too much, but I'm not sure what to do.

Any input? When it comes to Trilostane or Lysodren do you usually just go with what your vet is familiar with? Is there any way to decide if one is better than the other for your dog? Is one any safer? How do you decide when it is time? I am such a worrier anyway, and so, so busy now that my husband and I are back to teaching. If I have to put her on something else I really think I would drive her to my parents' house (they are retired) so someone could watch her all day. I feel like maybe it is complicated by all of the allergy issues. And maybe the up and down is normal. How long do they usually need to be on Cosequin to see an improvement?

Sorry for the long, rambling email. It has been swimming around in my head for a few days now. I have been trying to read to catch up on all of you, and I'm always thinking and talking about my "Cushing's group." I really don't know what I'd do without you guys.

Any thoughts are appreciated.

Julie & Hannah

[frijole]

I re read your entire thread to refresh my memory... couple things.. did you ever give the milk thistle? I ask because when I used it my dog's alkphos levels went down. I know it was recommended but not sure if you tried it. I throw it out there as if you are using it, maybe that is why the numbers are down and not the anipryl. I tend to agree with the others and your vet that maybe you should try not giving it to see what happens.

I see where you did the ldds test but never saw an acth test. I would be curious how high her cortisol levels are. That would tell you how 'advanced' the cushing's is. That would assist in deciding whether to treat or not.

I can see why you'd be asking questions about lysodren/trilostane but I still don't see enough symptoms that I'd go there yet. Of course this is the internet and I might be missing a whole lot of the picture so... you make the call there.

Regarding which is best - theyare equally effective but work differently. I think most go with what their vets are most comfortable with. I used lysodren and my gal did just fine.

Since you mentioned the itching - have you tried melatonin? It could be that the hormones are elevated (common in cush dogs) and as a result some dogs get skin issues which can include itching and licking. Melatonin is available at health food stores and I used it with my dog. She was a licker.

It seems like your biggest concern is the issue with jumping and stairs. Have you done xrays etc to eliminate those issues? If so it probably is cushings related.

I'm not sure I helped you a whole lot but those are my thoughts for now... Kim

[jmac]

Hi Kim,
Thanks for sharing your thoughts. I did not ever try the milk thistle, so it has to be the Anipryl. We decided not to try anything else just for that reason-so we would know what was causing what to happen. My vet has never done, nor suggested the ACTH test. I remember asking about it once, but I can't remember what he said. Do you think it would be worth checking, even if her symptoms are not that strong yet? I really still feel like we are not there yet. The main things I feel that I would be able to watch for are eating and drinking, and I'm not sure they are excessive enough. Should I test the hormone levels you talked about? I have heard of people using melatonin, but thought it was more to calm them. I will ask my vet about it when I talk to him. They have not done x-rays on her. Neither the regular vet nor the IM thought there was a point at the time it initially happened. They said they may not see anything and that a CAT scan might be better. I'm not spending money on a CAT scan at this point. I know my regular vet would do an x-ray in a heartbeat; he just didn't want me to pay for it if it was inconclusive. We had spent a lot at the time with her meds, visits, tests, and a $700 dental on my other dog. I am curious what her cortisol levels are. She doesn't have any skin issues yet, but I wonder if the Cushing's is making the itching worse.

You gave me lots of good things to think/ask about! Thanks!

Julie & Hannah

[frijole]

I wouldn't waste money on testing the sex hormones. I throw it out because based on what you have shared I agree that your dog has early signs of cushings and you shouldn't have to treat yet. That said, some dogs are classified as 'atypical' cushings early on and they have skin issues, itching, etc. Melatonin is a cheap and easy and safe treatment. I was wondering if it might not help with the licking and itching but if you think its allergies then go down the benedryl path.

What the acth test should tell you is how high the cortisol is.... that is an indication of how far along into cushings she is. The more uncontrolled the cushings the longer she's probably had it and the more likely you need to treat. That is why I throw that out... but really you are the one watching her and you'll know when its time to throw out some more money towards tests. Kim

[addy]

I know the struggle you are having, I went through it myself with Zoe, when to treat, how to treat, her symptoms, etc. I think agree with Kim that knowing the results of an ACTH test might shed some more light on it for you. If you feel you are not there yet to move to stronger treatment, then you go with your gut. You see Hannah every day and know her inside and out.

Zoe's hind leg is still a problem for her, I see it now, what she does with it, how she walks and will have new IMS check it out and since we lowered her cortisol somewhat, the arthritis in her front paw is flaring up again. Other than that, she is doing well.

You will know when to treat.

Love,
Addy